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目的探讨造血干细胞移植(HSCT)治疗恶性血液病的临床疗效及并发症的防治。方法51例急慢性白血病、恶性淋巴瘤、多发性骨髓瘤患者中,36例选择自体造血干细胞移植(auto-HSCT),15例接受异基因造血干细胞移植(allo-HSCT),包括HLA不全相合3例及非血缘关系移植4例,混合移植2例;预处理allo-HSCT主要选用CBV,BEAC方案,allo-HSCT采用BU/CY2及改良的BU/CY方案;移植物抗宿主病(GVHD)的预防采用CsA+MTX或CsA+MTX+MMF方案。结果51例患者中49例获得造血重建,在auto-HSCT和allo-HSCT后WBC≥1.0×109/L的中位时间分别为13d和17d,血小板≥20×109/L的中位时间分别为21和25d;40%出现aGVHD,26.7%出现cGVHD;3.9%出现HVOD;出血性膀胱炎发生率5.9%;CMV感染发生率33.3%;62.7%出现黏膜炎;54.9%出现不同部位的感染;移植相关死亡率3.5%,随访3～95个月,移植后复发11例,其中auto-HSCT9例,allo-HSCT2例。结论HSCT是目前治疗恶性血液病的最佳方法,但移植期间需要进一步探索如何减少其相关并发症,以提高血液肿瘤的治愈率及延长患者的无病生存时间。
Objective To investigate the clinical efficacy and prevention and treatment of hematopoietic stem cell transplantation (HSCT) in the treatment of hematologic malignancies. Methods Thirty-six patients with acute and chronic leukemia, malignant lymphoma and multiple myeloma were selected for auto-HSCT and 15 for allogeneic hematopoietic stem cell transplantation (allo-HSCT), including HLA-incompetent 3 4 cases of non-blood relationship and 2 cases of mixed transplantation were treated with CBV and BEAC in allo-HSCT preconditioning and BU / CY2 and BU / CY regimen in allo-HSCT. The graft-versus-host disease (GVHD) Prevent the use of CsA + MTX or CsA + MTX + MMF regimens. Results Among the 51 patients, 49 patients achieved hematopoietic reconstitution. The median time of WBC≥1.0 × 109 / L after auto-HSCT and allo-HSCT was 13d and 17d, respectively. The median time of platelets≥20 × 109 / L was 21 and 25d; 40% of aGVHD, 26.7% of cGVHD; 3.9% of HVOD; hemorrhagic cystitis incidence of 5.9%; CMV infection incidence of 33.3%; 62.7% of mucositis; 54.9% of different parts of the infection; The related mortality rate was 3.5%. The patients were followed up for 3 to 95 months. There were 11 cases of recurrence after transplantation, including 9 cases of auto-HSCT and 2 cases of allo-HSCT. Conclusion HSCT is the best method for the treatment of hematologic malignancies at present. However, it is necessary to further explore how to reduce the related complications during transplantation so as to improve the cure rate of hematological tumors and extend the disease-free survival time of patients.